CN103002840B - An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract - Google Patents
An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract Download PDFInfo
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- CN103002840B CN103002840B CN201080068086.1A CN201080068086A CN103002840B CN 103002840 B CN103002840 B CN 103002840B CN 201080068086 A CN201080068086 A CN 201080068086A CN 103002840 B CN103002840 B CN 103002840B
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0013—Implantable devices or invasive measures
- A61F5/0076—Implantable devices or invasive measures preventing normal digestion, e.g. Bariatric or gastric sleeves
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Abstract
An apparatus (11) for diverting biliopancreatic juices discharged into a patient's intestinal tract, comprising a tubular member (12) having an internal food isolating space (13) and a proximal sealing portion (14), a laterally open bile isolating cavity (19) configured to define together with an adjacent portion of intestinal wall a bile isolating space (19), a food sleeve portion (21 ) extending distally from the flexible tubular member (12), a bile diversion conduit (24) extending from the bile isolating cavity (19) in a distal direction and having a distal open bile conduit end (25).
Description
Technical field
The present invention relates generally to following apparatus and method, described apparatus and method are used for the digestion surgically affecting patient, it is intended to treat metabolism disorder, such as morbid obesity and relevant comorbidities (such as, diabetes), heart disease, apoplexy, lung disease and accidental disease.
Background technology
Attempt many non-operative treatment for morbid obesity, but in fact all there is no persistent success.
The surgical method for the treatment of morbid obesity, such as, for bad open, the abdominal cavity mirror of persistency food absorption and intracavity gastric bypass operation, has obtained increasingly extensive application and has obtained comparatively ten-strike.But the method at present for performing gastric bypass relates to the consuming time and dependent surgery operating technology of high sensitivity and to the remarkable of the gastrointestinal anatomical structure of patient and usual disadvantageous amendment.
In order to avoid gastric bypass operation shortcoming and affect the digestion of patient in more specifically and targetedly mode, the present invention emphatically research is used for major effect and adjustment intestinal-hepatic bile circulation but not gastral method and apparatus.For this reason, the following possibility method acting on intestinal-hepatic bile circulation and mechanism should be susceptible to:
-adjustment intestinal-hepatic bile cycle frequency, especially biliary cycle acceleration;
-adjust by the contact of the food of bile and enteral and interaction and the physiological signal that triggered by bile and contacting of intestinal wall;
-by adjustment bile and food or chyme at the attaching space of enteral with time of contact and by making bile and food be separated the absorbability adjusting food targetedly.
For Digestive system such as bile and pancreatic juice distally being transferred to enteral known devices and method at US 2009/0062717 and US 7,314, discuss to some extent in 489.Be disclosed in US 7,314, the device in 489 comprises support, described support there is far-end and the duodenal near-end that engages in weary Te Shi ampulla region and between near-end and far-end to produce the reduction diameter parts can collecting the endless belt volume of bile.The device be disclosed in US 2009/0062717 comprises bearing support and conduit, and described bearing support has lateral opening, and described conduit extends being connected between the near-end of lateral opening and distal open end, and the near-end of wherein said conduit can form reservoir.
For these known devices and the method collection bile of shift and assimilation liquid, but they do not affect particularly or change bile contacts and interactional Time and place with intestinal wall with food.
Therefore for a change bile and food to contact with intestinal wall and interactional natural time and space, to cause weight saving and/or to allow in the mode of especially Wicresoft to control diabetes object of the present invention.
Realize this object by the equipment for shifting the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing, described equipment comprises:
A) flexible tubular element, described tubular element has:
-inner food insulating space and
-proximal seal part, described proximal seal part can engage intestinal wall and flow between tubular element and intestinal wall to prevent food,
-proximal open end, described proximal open end can be received food stream and food stream be guided in food insulating space,
-distal open end, described distal open end can discharge food stream from food insulating space,
The open bile separate cavities of-side direction, the open bile separate cavities of described side direction is formed by the outer surface of tubular element and can limit bile insulating space together with the adjacent part of intestinal wall,
B) food sleeve portion, described food sleeve portion distally extends from the distal open end of the tubular element of flexibility and has open distally food sleeve end, and described food sleeve portion limits food conveying space in inside,
C) bile transfer conduit, described bile transfer conduit distally extends from bile separate cavities and has open distally bile duct end, and described bile transfer conduit limits the bile conveying space of isolating with described food conveying space in inside.
Food or chyme and intestinal wall are isolated by this equipment in the region in tubular element distally, bile are not entered oddi's sphincter from bile separate cavities and transfer to the position (open bile duct end) independent of the region isolated with chyme simultaneously.
Summary of the invention
According to an aspect of the present invention, the distal open end of bile transfer conduit is positioned at the position in the distally of the open sleeve end in distally.
This allows the primary importance in the tubular element distally of flexibility to distribute food and contacts intestinal wall to make food, and allow to distribute bile or gallbladder pancreatic juice in the enteral second position in primary importance more distally, contact (such as with intestinal wall to make bile, distal jejunum or ileum wall) and after chyme stream has been divided a word with a hyphen at the end of a line along intestinal and contacted the intestinal of isolating with bile, contact with chyme stream with partial digested food.Therefore, for naturalness, attaching space and the time of food-bile-intestinal are significantly changed, thus affect food absorption and the circulation of intestinal hepatic bile loses weight and/or the control of diabetes to obtain.
According to another aspect of the present invention, bile transfer conduit comprises outer cover, and described outer cover limits the annular bile conveying space around food sleeve portion.
According to another aspect of the present invention, bile conveying space is limited by the outer surface of food sleeve portion and surrounding intestinal wall part, to make bile to isolate with food stream but the mode contacted with intestinal wall distally flows in intestinal from tubular element.
According to another aspect of the present invention, bile transfer conduit comprises the conduit being arranged in food sleeve portion outside, to allow the bile of isolating independent of intestinal wall and chyme flowing.
According to another aspect of the present invention, food sleeve portion is proximally hermetic unit extension directly, thus forms duodenal sleeve.
According to another aspect of the present invention, the distal open end of bile duct passes into food sleeve portion in the position of distal openings sleeve end nearside, allows thus:
-gallbladder pancreatic juice and food flow into Part I, and wherein both is isolated from each other and isolates with wall of the lumen;
-gallbladder pancreatic juice and food stream are being arranged in Part I distally and the Part II of still isolating with wall of the lumen mixes;
-food contacts with intestinal wall with the position of gallbladder pancreatic juice in Part II distally.
According to another aspect of the present invention, described equipment comprises the biliary drainage catheter extended between the proximal and distal ends, and described near-end has support to connect the biliary drainage catheter in biliary ductal tree, and described far-end connects the tubular element be communicated with bile separate cavities fluid.This allows optionally to trap bile in biliary ductal tree and/or pancreatic juice and is guided in bile separate cavities.
Above-mentioned purpose of the present invention is also realized by the method for shifting the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing, and described method comprises:
A) the bile insulating space between device and intestinal wall is formed at weary Te Shi ampulla region place;
B) food stream is separated in the region of bile insulating space far-end with intestinal wall;
C) bile of isolation is transferred to the position in the distally in the region that wherein food stream is separated with intestinal wall from bile insulating space.
According to an aspect of the present invention, the step of the bile of transfer isolation comprises the steps: the position in distally bile transfer conduit being extended to the region that wherein food stream is separated with intestinal wall at intracavity from bile insulating space along distal direction.
According to another aspect of the present invention, the step of bile of transfer isolation comprises the steps: to be communicated with by intestinal-Surgical healing or by forming direct tube chamber between the intestinal wall of intestinal-endogenous tissue pipe-Surgical healing in bile insulating space and the distally target position of intestinal.
Accompanying drawing explanation
By accompanying drawing and explanation thereof, these and other aspect of the present invention and advantage will become obvious, described accompanying drawing and explanation thereof show embodiments of the invention, and together with the detailed description of the invention of the whole description of the present invention provided above and the embodiment hereafter provided for explaining principle of the present invention.
-Fig. 1 shows the method and apparatus for shifting the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing according to the first embodiment of the present invention;
-Fig. 2 shows the details of the equipment in Fig. 1;
-Fig. 2 A shows the details of equipment according to a second embodiment of the present invention;
-Fig. 3 shows the details of equipment according to the third embodiment of the invention;
-Fig. 4 shows the details of equipment according to a fourth embodiment of the invention;
-Fig. 5 shows the details of equipment according to a fifth embodiment of the invention;
-Fig. 6-12 shows according to an embodiment of the invention for equipment being anchored to the apparatus and method in gastrointestinal tract;
-Figure 13 shows the details of equipment according to a sixth embodiment of the invention;
-Figure 14 shows the details of equipment according to a seventh embodiment of the invention;
-Figure 15 A and 15B shows the details of the equipment according to the eighth embodiment of the present invention;
-Figure 16 shows the details of equipment according to another embodiment of the invention;
-Figure 17 shows method and apparatus according to another embodiment of the invention.
Detailed description of the invention
See accompanying drawing, the anatomical structure that wherein similar in multiple view digitized representation is similar and parts, Fig. 1 is the partial view in the abdominal cavity of patient, illustrated therein is the gastrointestinal tract with esophagus 1, stomach 2, duodenum 3, jejunum 4, ileum 5, colon 6, and there is liver, comprise the biliary ductal tree 7 of gallbladder 8, the liver and gall of the major duodenal papilla 10 (bile and pancreatic juice normally enter duodenum 3 through it) of ductus pancreaticus 9 and weary Te Shi ampulla, and for shifting the equipment 11 of the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing.
According to embodiment, equipment 11 comprises the tubular element 12 of preferred flexible, described tubular element 12 has inner food insulating space 13 and at least proximal seal part 14, and described proximal seal part 14 can engage intestinal wall and flow between tubular element 12 and intestinal wall to prevent intestinal wall.Tubular element 12 also forms proximal open end 16 and distal open end 17, and described proximal open end 16 can be received food stream and be guided in food insulating space 13, and described distal open end 17 can discharge food stream from food insulating space 13.The outer surface 18 of tubular element 12 is to form the mode molding of the open bile separate cavities 19 of side direction, and the open bile separate cavities 19 of described side direction can limit bile insulating space 19 together with the adjacent part of intestinal wall.
Equipment 11 also comprises food sleeve portion 21, and described food sleeve portion 21 distally extends from the distal open end 17 of the tubular element 12 of flexibility and has open distally food sleeve end 22.Food sleeve portion 21 limits food conveying space 23 in inside.
In addition, bile transfer conduit 24 can extend from bile separate cavities 19 along distal direction and have open distally bile duct end 25.Bile transfer conduit limits the bile conveying space 26 of isolating with food conveying space 23 in inside.
This equipment such as per os can be inserted and is formulated in 12 rectum at weary Te Shi nipple area 10 place, cover weary Te Shi nipple 10 to receive gallbladder pancreatic juice to make bile separate cavities 19.According to this location, equipment 11 allows food or chyme and intestinal wall to isolate in the region in tubular element 12 distally, allows bile to transfer to position independent of the region isolated with chyme from bile separate cavities 19 simultaneously, and without the need to entering oddi's sphincter.
According to embodiment, tubular element 12 can support, and described support can be anchored in small intestinal, and especially gallbladder pancreatic juice normally enters in the duodenum 3 at weary Te Shi nipple 10 place of intestinal, and can trap gallbladder pancreatic juice and be guided in bile transfer conduit 24.
In the exemplary embodiment, bile separate cavities 19 comprises radially outer annular chamber, and described radially outer annular chamber is formed around bile insulating space 20 and the distally tube chamber hermetic unit 15 that the nearside tube chamber hermetic unit 14 given prominence to by radial direction and radial direction are given prominence to axially defines.
Tube chamber hermetic unit 14, the 15 larger configurations of radial direction that can be expanded to expansion from the less configuration of the radial direction of initial contraction, the less configuration of radial direction of described initial contraction allows selected duodenal segment equipment 11 being introduced and is transported to weary Te Shi nipple 10 place through tube chamber (per os), the larger configuration of radial direction of described expansion allows tube chamber hermetic unit 14,15 closely engage wall of the lumen and tubular element 12 is anchored to wall of the lumen.
For this reason, tube chamber hermetic unit 14,15 can comprise inflatable balloon section, and described inflatable balloon section permanently expands by injecting expansion fluid such as saline solution or setting expansion agent such as hardening polymer foam or paste.
According to embodiment, distally tube chamber hermetic unit 15 also can limit one or more bile access opening 27, and described bile access opening 27 extends to bile transfer conduit 24 from bile separate cavities 19 and both is placed to fluid and is communicated with.
According to embodiment, the distal open end 25 of bile transfer conduit 24 is positioned at the position in open sleeve end 22 distally, distally.This allows the distribution of the primary importance in tubular element 12 distally of flexibility food to contact with intestinal wall to make food, and allow to distribute bile or gallbladder pancreatic juice in the enteral second position in primary importance more distally, to make bile and intestinal wall (such as, distal jejunum or ileum wall) contact, and after chyme stream has been divided a word with a hyphen at the end of a line along intestinal and contacted the intestinal of isolating with bile, contact with partial digested food or chyme stream.
According to another embodiment (Fig. 2,3), bile transfer conduit 24 can comprise outer cover 28, substantially coaxial with food the sleeve portion 21 and annular bile conveying space 26 limited around food sleeve portion 21 of described outer cover 28.In this embodiment, the position of distally bile duct end 25 is depended on the length of outer cover 28 and can be positioned at the position of the nearside of distally food sleeve end 22, to make:
-in first pipeline 29 in tubular element 12 distally, food stream and bile flow are isolated from each other and isolate with intestinal wall,
-in the first pipeline 29 distally and in the second pipe 30 that distally bile duct end 25 distally extends, bile contacts with intestinal wall, and food stream is still isolated with bile and intestinal wall, and
-in second pipe 30 distally and in the 3rd pipeline 31 that distally food sleeve end 22 distally extends, food stream mixes with remaining still unabsorbed bile and contacts with intestinal wall (Fig. 3).
In alternative exemplary embodiment (Fig. 2 A), the position of distally bile duct end 25 can be positioned at the position of the nearside of distally food sleeve end 22, to make:
-in first pipeline 32 in tubular element 12 distally, food stream and bile flow are isolated from each other and isolate with intestinal wall,
-in the first pipeline 32 distally and in the second pipe 33 that distally food sleeve end 22 distally extends, food stream mixes with bile, and food stream and bile are still isolated with intestinal wall, and
-in second pipe 33 distally and in the 3rd pipeline 34 that distally bile duct end 25 distally extends, food contacts with intestinal wall with bile.
In alternative embodiment (Fig. 4), bile conveying space 26 is limited by the outer surface 35 of food sleeve portion 21 and surrounding intestinal wall part, to make bile to isolate with food stream but the mode contacted with intestinal wall distally flows into intestinal 36 from tubular element 12.
According to exemplary embodiment (Fig. 5), bile transfer conduit 24 comprises the conduit being arranged in food sleeve portion 21 outside, thus allows the bile of isolation independent of intestinal wall and chyme or flow of food.
In this embodiment, the position of distally bile duct end 25 is depended on the length of outer conduit and can be positioned at the position in the distally of distally food sleeve end 22, to make:
-in first pipeline 37 in tubular element 12 distally, food stream and bile flow are isolated from each other and isolate with intestinal wall,
-in the first pipeline 37 distally and in the second pipe 38 that distally food sleeve end 22 distally extends, food stream contact intestinal wall, and bile is still isolated with food and intestinal wall, and
-in second pipe 38 distally and in the 3rd pipeline 39 that distally bile duct end 25 distally extends, bile mixes with remaining still unabsorbed food and contacts with intestinal wall (Fig. 5).
(not shown) in alternative exemplary embodiment, the position of distally bile duct end 25 can be positioned at the position of the nearside of distally food sleeve end 22, to make:
-in first pipeline in tubular element 12 distally, food stream and bile flow are isolated from each other and isolate with intestinal wall,
-in the first pipeline distally and in the second pipe that distally bile duct end 25 distally extends, bile contacts with intestinal wall, and food stream is still isolated with bile and intestinal wall, and
-in second pipe distally and in the 3rd pipeline that distally food sleeve end 22 distally extends, food mixes with remaining still unabsorbed bile and contacts with intestinal wall.
According to another embodiment, food sleeve portion can from proximally can extending in conjunction with the nearside tube chamber hermetic unit 14 carrying out described in the embodiment of Fig. 1 and 2 constructing, formed thus and can insert gastrointestinal tract and be anchored on the duodenal sleeve device of its certain position by per os, wherein nearside tube chamber hermetic unit is positioned at some centimeters of such as weary Te Shi nipple 10 near-end (upstream).
According to exemplary embodiment, the distal open end 25 of bile transfer conduit 24 can pass in food sleeve portion 21 in certain position of distally open sleeve end 22 near-end, making (when by described apparatus preparing to the gastrointestinal tract of patient time):
-in first pipeline in tubular element 12 distally, gallbladder pancreatic juice and food stream are isolated from each other and isolate with wall of the lumen;
-in the second pipe of the first pipeline far-end, gallbladder pancreatic juice mixes with food stream, but still isolates with wall of the lumen;
-in the 3rd pipeline of second pipe far-end, food contacts with intestinal wall with gallbladder pancreatic juice.
According to another exemplary embodiment (Figure 13), equipment 11 is included in the biliary drainage catheter 40 extended between near-end 41 and far-end 43, described near-end 41 has support 42 to connect the biliary drainage catheter 40 in biliary ductal tree 7, and the mode that described far-end 43 is communicated with fluid with the bile separate cavities 19 of tubular element 12 is connected.This allows optionally to trap bile in biliary ductal tree 7 and/or pancreatic juice and is guided in bile separate cavities 19.
Equipment 11 can comprise outer cover 44, and described outer cover 44 partly extends and is connected with it in the mode limiting annular bile insulating space 45 in outer cover 44 and tubular element 12 on tubular element 12, isolates to make bile insulating space and intestinal wall.Outer cover 44 has the lateral branching passing in bile insulating space 45 and form above-mentioned biliary drainage catheter 40.According to embodiment, the near-end 41 of biliary drainage catheter 40 can be located and is anchored in the common bile duct in coupled position downstream of common bile duct and ductus pancreaticus 9, to make bile drain into together with pancreatic juice in bile insulating space 45.Alternatively, the near-end 41 of biliary drainage catheter 40 can be located and is anchored in the common bile duct of coupled position upstream of common bile duct and ductus pancreaticus 9, with make only by biliary drainage in bile insulating space 45, and pancreatic juice naturally can be discharged in duodenum 3 and to flow into intestinal in gap between wall of the lumen and the outer surface of outer cover 44.
Figure 14 shows another exemplary embodiment, wherein outer cover 44 can limit bile insulating space 20 and independent pancreatic juice insulating space 46, and described pancreatic juice insulating space 46 is isolated with bile insulating space and the pancreatic juice had apart from distally bile duct end 25 1 distance exports 47.The portions of proximal of biliary drainage catheter 40 can be bifurcated, to limit biliary drainage end 41 and pancreatic juice drainage end 48, described biliary drainage end 41 can be located and is anchored in the common bile duct of coupled position upstream of common bile duct and ductus pancreaticus 9, and described pancreatic juice drainage end 48 can be positioned in ductus pancreaticus 9.Biliary drainage catheter 40 also can comprise internal diaphragm 51, described internal diaphragm 51 extends to bile insulating space 45 and pancreatic juice insulating space 46 from bifurcation site, to make by biliary drainage in bile insulating space 45, and by pancreatic juice drainage in pancreatic juice insulating space 46.
According to embodiment, pancreatic juice outlet 47 is directly arranged on food insulating space 13, mixes, but isolate (Figure 14) with intestinal wall with the natural place making pancreatic juice and food stream roughly contact at them.
According to another aspect of the present invention, equipment 11 can be included in the proximal collar 49 (being shown in such as Fig. 1 and 2 A) extended between infundibulate proximal open end 50 and distal open end 52, described infundibulate proximal open end 50 can such as by being anchored in stomach 2 with pylorus conformal connection, and described distal open end 52 is connected to the proximal aperture 16 of tubular element 12.Proximal collar 49 can anchoring arrangement 11 to resist peristaltic forces preferably, and the food that is contained in stomach 2 can be collected and it is guided in food insulating space 13 when not contacting intestinal wall.
Alternatively or in addition, in order to the peristaltic forces of resistant function on equipment 11, can such as by stomach coil 53 by the grappling of described equipment 11 in the gastrointestinal tract, described stomach coil 53 can from extended configuration (can be interior to stomach 2 by its per os or intranasal delivery) elastic deformation for screwing arc or circular in configuration (can conformably engage stomach 2 to provide grappling to the anchor lines 54 of the near-end being connected to tubular element 12) (Figure 11).
In another exemplary embodiment shown in Figure 12, such as anchor lines 54 can be connected to by T-shaped hoop the folding folds in a garment 55 previously formed in coat of the stomach.
In another exemplary embodiment shown in Fig. 6, by being with 56 under mucosa, equipment 11 is anchored to intestinal wall, be with 56 to insert in wall of the lumen under described mucosa and extend around it completely, form anchor ring thus to produce bottleneck portion in intestinal wall, described bottleneck portion can engage the tube chamber hermetic unit 14 being formed at such as tubular element 12, the respective annular Anchorage slots 57 in the one in 15.
Fig. 7 shows another exemplary embodiment, wherein by rami gastrici frame 58 and attachment can elastic expansion formula (possibly shape memory) camber member 59 by equipment 11 grappling in the gastrointestinal tract, described camber member 59 can form conformal connection with stomach 2.
Fig. 8 shows another exemplary embodiment, and wherein by T-shaped hoop 60 by equipment 11 grappling in the gastrointestinal tract, described T-shaped hoop 60 hits from the inside of intestinal to deliver to intestinal wall and forms fixed position thus and be connected with the near-end of tubular element 12.
Fig. 9 and 9A shows another exemplary embodiment, wherein by there is the annular anchoring part 61 of multiple grappling barb 62 by equipment 11 grappling in the gastrointestinal tract, described barb 62 can move (such as from resting position, rotate) to operating position, with the unobstructed intracavity conveying of permission equipment 11 in the circumference that barb 62 is contained in anchor portion 61 in described resting position, in described operating position, barb 62 is radially outward given prominence to, and pierces through wall of the lumen thus and thus equipment 11 is anchored to wall of the lumen.
In another exemplary embodiment shown in Figure 10-10C, by having the tubular anchor certain portions 63 of one or more anchor hole 64 by equipment 11 grappling in the gastrointestinal tract, described anchor hole 64 is designed to towards intestinal wall part and can allows these intestinal wall parts to be pulled in hole 64 and to fix with it.Can be provided for from tubular anchor certain portions 63 internal suction wall of the lumen part and the intracavity aspirator 55 be pulled in anchor hole 64 and swelling with the apparatus and method preventing it from retracting from anchor hole 64 for generation of permanent (mushroom-head) of wall of the lumen part.These permanent swelling apparatus and method for generation of wall of the lumen part can comprise will be injected under extender or sclerosing agent mucosa or plasticity bead (poly-(methyl methacrylate) PMMA) be introduced the tissue part being previously drawn through anchor hole 64.
With reference to Figure 15 A and 15B, outer cover 65 can be provided with sidewise hole 66, and described sidewise hole 66 can be placed on oddi's sphincter to be defined for the space that isolation is discharged to ID bile.In the edge around sidewise hole 66 and the edge at the near-end 67 around outer cover 65, reinforcing network 68 can be adhered to sleeve pipe to provide the reinforcing of seam area.In addition, surgery felt rug 69 can be applied in the region of reinforcing network 68 with stitching area the outside of outer cover 65.The edge of proximal edge 67 and sidewise hole 66 can be sewn onto duodenal wall, to make sidewise hole 66 be arranged on around oddi's sphincter, thus form No leakage with wall of the lumen and be connected, be suitable for thus limiting food stream and bile insulating space, as previously mentioned.In addition, to prevent suture from cutting serous coat and tractive goes out wall of the lumen in the seam area that the continuous or discontinuous outside gauze 70 become by surgery felt can be arranged in duodenal wall outside.
According to another exemplary embodiment of the present invention, can duckbill outlet valve (not shown in detail) be arranged in the remote area of food sleeve portion 21 and/or bile transfer conduit 24, backflow and infection risk to prevent chyme.
Figure 16 shows another exemplary embodiment of the equipment for isolating food, bile, stomachial secretion liquid and 12 rectum juices, wherein said equipment comprises three sleeve pipes 72,73,74, described sleeve pipe 72,73,74 to insert coaxially each other and to have the different proximal inlet port being positioned at diverse location and the different distal outlet port being positioned at diverse location with at assigned address isolation and mixing juice.
Independent of described apparatus embodiments, the invention still further relates to the method for shifting the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing, described method comprises:
A) the bile insulating space between equipment and intestinal wall is formed at weary Te Shi ampulla region place;
B) food stream is separated in the region of bile insulating space far-end with intestinal wall;
C) bile of isolation is transferred to the position in the distally in the region that wherein food stream is separated with intestinal wall from bile insulating space.
According to embodiment, the step of the bile of transfer isolation comprises the steps: the position in distally bile transfer conduit being extended to the region that wherein food stream is separated with intestinal wall at intracavity from bile insulating space along distal direction.
According to another exemplary embodiment (Figure 17), the step of bile of transfer isolation comprise the steps: by intestinal-Surgical healing or by endogenous intracavity bypass 71 (have coincide to the intestinal wall in bile insulating space near-end and coincide to the far-end of the distally target position of intestinal) intestinal wall in bile insulating space and form direct tube chamber between the distally target position of intestinal and be communicated with, to make isolated by bypass 71 and shift bile, isolated by food sleeve portion 21 simultaneously and carry food stream.
Although describe the preferred embodiments of the present invention in detail, the object of applicant is not that the scope of claim is limited to these specific embodiments, but contains all modifications form and alternative constructions that are within the scope of the present invention.
Claims (15)
1. one kind for shifting the equipment (11) of the gallbladder pancreatic juice be discharged in Intestinal Mucosal Injury in Patients Undergoing, and comprise tubular element (12), described tubular element (12) has:
-inner food insulating space (13) and proximal seal part (14), described proximal seal part (14) can engage intestinal wall and flow between described tubular element (12) and described intestinal wall to prevent food,
-proximal open end (16) and distal open end (17), described proximal open end (16) can be received food stream and food stream be guided in described food insulating space (13), described distal open end (17) can from described food insulating space (13) release food stream
The open bile separate cavities (19) of-side direction, the open bile separate cavities (19) of described side direction can limit bile insulating space (19) together with the adjacent part of intestinal wall, and described equipment (11) also comprises:
-food sleeve portion (21), described food sleeve portion (21) distally extends from the distal open end (17) of the tubular element (12) of flexibility and has the open food sleeve end (22) in distally, described food sleeve portion (21) limits food conveying space (23) in inside
-bile transfer conduit (24), described bile transfer conduit (24) extends from described bile separate cavities (19) along distal direction and has the open bile duct end (25) in distally, described bile transfer conduit limits the bile conveying space (26) of isolating with described food conveying space (23) in inside
-tubular element outer cover (44), described tubular element outer cover (44) extends and is connected with it on described tubular element (12), described connected mode makes to limit endless belt bile insulating space (45) between described tubular element outer cover (44) and described tubular element (12), and described tubular element outer cover (44) has the lateral branching passing in described bile insulating space (45) and form described biliary drainage catheter (40).
2. equipment according to claim 1 (11), the distal open end (25) of wherein said bile transfer conduit (24) is positioned at the position in open sleeve end (22) distally, described distally.
3. equipment according to claim 1 (11), the distal open end (25) of wherein said bile transfer conduit (24) can pass in described food sleeve portion (21) in the position of described distally open sleeve end (22) nearside.
4. equipment according to claim 1 (11), the open sleeve end in wherein said distally (22) can pass in described bile transfer conduit (24) in the position of distal open end (25) nearside of described bile transfer conduit (24).
5. equipment according to claim 1 (11), wherein said tubular element (12) is the support that can be anchored in small intestinal, at described small intestinal place, gallbladder pancreatic juice normally enters described intestinal, and described support can trap described gallbladder pancreatic juice and be guided in described bile transfer conduit (24), wherein said bile separate cavities (19) comprises annular chamber, described annular chamber to be formed and the nearside tube chamber hermetic unit (14) given prominence to by radial direction and outstanding distally tube chamber hermetic unit (15) axis of radial direction define around described bile insulating space (20).
6. equipment according to claim 5 (11), wherein said tube chamber hermetic unit (14,15) can be expanded to the larger configuration of radial direction of expansion from the less configuration of the radial direction of initial contraction.
7. equipment according to claim 6 (11), wherein said tube chamber hermetic unit (14,15) comprises the inflatable balloon section that permanently can expand by injecting expansion fluid.
8. equipment according to claim 1 (11), wherein said bile transfer conduit (24) comprises the food sleeve portion outer cover (28) coaxial with described food sleeve portion (21), thus limits the annular bile conveying space (26) around described food sleeve portion (21).
9. equipment according to claim 1 (11), wherein said bile transfer conduit (24) comprises the conduit being arranged in described food sleeve portion (21) outside.
10. according to equipment in any one of the preceding claims wherein (11), be included in the biliary drainage catheter (40) extended between near-end (41) and far-end (43), described near-end (41) can be arranged in biliary ductal tree (7), and the mode that described far-end (43) is communicated with fluid with described bile separate cavities (19) is connected.
11. equipment according to claim 1 (11), wherein said tubular element outer cover (44) limits described bile insulating space (20) and independent pancreatic juice insulating space (46), described pancreatic juice insulating space (46) has pancreatic juice outlet (47) apart from described distally bile duct end (25) distance, the portions of proximal of wherein said biliary drainage catheter (40) be bifurcated and form biliary drainage end (41) and pancreatic juice drainage end (48), and described biliary drainage catheter (40) comprises the internal diaphragm (51) extending to described bile insulating space (45) and pancreatic juice insulating space (46) from described bifurcation site.
12. equipment according to claim 11 (11), wherein said pancreatic juice outlet (47) is directly arranged on described food insulating space (13).
13. equipment according to claim 1 (11), comprise proximal collar (49), described proximal collar the infundibulate proximal open end (50) that can be anchored in stomach (2) and be connected to described tubular element (12) proximal aperture (16) distal open end (52) between extend.
14. equipment according to claim 1 (11), comprise for by described tubular element (11) grappling anchoring device in the gastrointestinal tract, described anchoring device is selected from:
-stomach coil (53), described stomach coil (53) can from extended configuration elastic deformation for can with stomach (2) conformal be connected screw arcuate configuration, to be provided for the anchoring body of the anchor lines (54) of the near-end being connected to described tubular element (12)
-anchor lines (54) and multiple T-shaped hoop, described anchor lines can be connected to the folding folds in a garment (55) in coat of the stomach by described T-shaped hoop,
(56) are with under-mucosa, be with (56) can to insert in wall of the lumen under described mucosa to form anchor ring in intestinal wall, the corresponding annular anchoring groove (57) be formed in described tubular element (12) can be engaged
-rami gastrici frame (58) and attachment can elastic expansion formula camber member (59), describedly can form conformal connection with stomach (2) by elastic expansion formula camber member (59),
-T-shaped hoop (60), described T-shaped hoop (60) can be applied to from the inside of intestinal intestinal wall and to be connected with the near-end of described tubular element (12),
-annular anchoring part (61), described annular anchoring part (61) has multiple grappling barb (62), described barb (62) can move to the radially outward outstanding operating position of wherein said barb (62) from retraction formula resting position
-tubular anchor certain portions (63) and for generation of wall of the lumen part permanent mushroom-head swelling thus prevent the device that it is retracted from anchor hole (64), described tubular anchor certain portions (63) has one or more described anchor hole (64), one or more described anchor hole (64) can to allow these intestinal wall parts to be pulled in described hole (64) towards intestinal wall part and is fixed to the upper
-there is the outer cover (65) of near-end and the sidewise hole (66) that can be sewn onto duodenal wall, place around oddi's sphincter to make described sidewise hole (66), described outer cover comprises the reinforcing network (68) at the edge of the edge that is adhered to around described sidewise hole (66) and the near-end (67) around described outer cover (65), described reinforcing network provides the seam area of reinforcing, surgery felt rug (69) is applied in the region of described reinforcing network (68) outside of described outer cover (65).
15. equipment according to claim 1 (11), comprise duckbill outlet valve, described duckbill outlet valve is arranged in the remote area of at least one in described food sleeve portion (21) and described bile transfer conduit (24).
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EP2010/060278 WO2012007048A1 (en) | 2010-07-16 | 2010-07-16 | An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN103002840A CN103002840A (en) | 2013-03-27 |
| CN103002840B true CN103002840B (en) | 2015-05-20 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201080068086.1A Active CN103002840B (en) | 2010-07-16 | 2010-07-16 | An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN103002840B (en) |
| WO (1) | WO2012007048A1 (en) |
Families Citing this family (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| ITRM20110379A1 (en) * | 2011-07-19 | 2013-01-20 | Francesco Greco | IMPLANTABLE SYSTEM FOR OBESITY TREATMENT. |
| EP2561839B1 (en) * | 2011-08-23 | 2014-03-26 | Ethicon Endo-Surgery, Inc. | Device for anchoring an endoluminal sleeve in the GI tract |
| US10765304B2 (en) * | 2015-09-28 | 2020-09-08 | Bio-Medical Engineering (HK) Limited | Endoscopic systems, devices, and methods for performing in vivo procedures |
| KR101994935B1 (en) * | 2017-06-07 | 2019-07-01 | (의)삼성의료재단 | PH measuring apparatus and PH monitoring system comprising the same |
| CN113171538B (en) * | 2021-05-06 | 2023-05-02 | 海安市人民医院 | Cut-off equipment for intestinal tract treatment |
Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2005120363A1 (en) * | 2004-06-03 | 2005-12-22 | Mayo Foundation For Medical Education And Research | Obesity treatment and device |
| WO2007103773A2 (en) * | 2006-03-02 | 2007-09-13 | Laufer Michael D | Gastrointestinal implant and methods for use |
| US7476256B2 (en) * | 2003-12-09 | 2009-01-13 | Gi Dynamics, Inc. | Intestinal sleeve |
Family Cites Families (9)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6675809B2 (en) * | 2001-08-27 | 2004-01-13 | Richard S. Stack | Satiation devices and methods |
| US7314489B2 (en) | 2003-08-20 | 2008-01-01 | Ethicon Endo-Surgery, Inc. | Method and apparatus to facilitate nutritional malabsorption |
| US8376981B2 (en) * | 2006-03-02 | 2013-02-19 | Michael D. Laufer | Gastrointestinal implant and methods for use |
| US20080228126A1 (en) * | 2006-03-23 | 2008-09-18 | The Trustees Of Columbia University In The City Of New York | Method of inhibiting disruption of the healing process in a physically modified stomach |
| US20070282418A1 (en) * | 2006-05-30 | 2007-12-06 | Boston Scientific Scimed, Inc. | Anti-obesity flow controller |
| US7867283B2 (en) * | 2006-05-30 | 2011-01-11 | Boston Scientific Scimed, Inc. | Anti-obesity diverter structure |
| US7922684B2 (en) * | 2006-05-30 | 2011-04-12 | Boston Scientific Scimed, Inc. | Anti-obesity dual stent |
| US8002731B2 (en) * | 2006-05-30 | 2011-08-23 | Boston Scientific Scimed, Inc. | Anti-obesity stent |
| US20090093767A1 (en) * | 2007-10-04 | 2009-04-09 | Brian Kelleher | Devices and methods for endolumenal therapy |
-
2010
- 2010-07-16 WO PCT/EP2010/060278 patent/WO2012007048A1/en active Application Filing
- 2010-07-16 CN CN201080068086.1A patent/CN103002840B/en active Active
Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7476256B2 (en) * | 2003-12-09 | 2009-01-13 | Gi Dynamics, Inc. | Intestinal sleeve |
| WO2005120363A1 (en) * | 2004-06-03 | 2005-12-22 | Mayo Foundation For Medical Education And Research | Obesity treatment and device |
| WO2007103773A2 (en) * | 2006-03-02 | 2007-09-13 | Laufer Michael D | Gastrointestinal implant and methods for use |
Also Published As
| Publication number | Publication date |
|---|---|
| CN103002840A (en) | 2013-03-27 |
| WO2012007048A1 (en) | 2012-01-19 |
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